Patient-specific glenoid guide with a reusable guide holder

ABSTRACT

A glenoid device for preparing a shoulder joint of a patient includes a reusable guide holder having a body between an upper surface and a lower surface and a bore passing through the body of the guide holder. The glenoid device also includes a patient-specific glenoid guide having a body with an upper and lower surface. The lower surface of the patient-specific glenoid guide is configured as a negative surface of a glenoid face based on preoperative image scans of the shoulder joint of the patient. The upper face of the patient-specific glenoid guide is configured to be coupled and contact the lower face of the guide holder, such that the bore of the guide holder is aligned along a patient-specific bore through the body of the patient-specific glenoid guide and along a corresponding alignment axis of the patient-specific glenoid guide.

INTRODUCTION

In shoulder arthroplasty various guides and instruments are used to determine an alignment axis and guide an implant for anatomic or reverse shoulder arthroplasty. The present teachings provide various patient-specific and reusable guide instruments for use in shoulder arthroplasty.

SUMMARY

The present teachings provide a glenoid device that includes a non-custom guide holder and a patient-specific glenoid guide for anatomic and/or reverse shoulder arthroplasty.

The present teachings provide a glenoid device for preparing a shoulder joint of a patient includes a reusable guide holder having a body between an upper surface and a lower surface and a bore passing through the body of the guide holder. The glenoid device also includes a patient-specific glenoid guide having a body with an upper and lower surface. The lower surface of the patient-specific glenoid guide is configured as a negative surface of a glenoid face based on preoperative image scans of the shoulder joint of the patient. The upper face of the patient-specific glenoid guide is configured to be coupled and contact the lower face of the guide holder, such that the bore of the guide holder is aligned along a patient-specific bore through the body of the patient-specific glenoid guide and along a corresponding alignment axis of the patient-specific glenoid guide.

The present teachings also provide a method of preparing a shoulder joint of a patient for arthroplasty. The method includes attaching a reusable non-custom guide holder to a patient-specific glenoid guide. The patient-specific glenoid guide has a patient-specific lower surface configured to nestingly mate and conform to a corresponding surface of a glenoid face of the patient based on a three-dimensional image of a shoulder joint of the patient reconstructed preoperatively from image scans of the shoulder joint of the patient. The patient-specific lower surface is mated to the glenoid face. A guiding pin is passed through a bore of the guide holder and through a bore of the patient-specific glenoid guide along a patient-specific alignment orientation of the shoulder joint of the patient. The guiding pin is inserted into the glenoid face. The guide holder and the patient-specific glenoid guide are removed without removing the guiding pin. The guiding pin can be used to prepare the shoulder joint for arthroplasty.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from the detailed description and the accompanying drawings.

FIG. 1 is an environmental view of a reusable holder and a patient-specific glenoid guide shown in use for anatomic shoulder arthroplasty according to the present teachings;

FIG. 1A is a side view of an alternative reusable guide holder;

FIG. 2 is an environmental view of reusable holder and a patient-specific glenoid guide shown in use for reverse shoulder arthroplasty according to the present teachings;

FIG. 3 is perspective top environmental view of the patient-specific glenoid guide of FIG. 1;

FIG. 4 is perspective top environmental view of the patient-specific glenoid guide of FIG. 2;

FIG. 5 is a sectional view of the reusable guide holder and a patient-specific glenoid guide of FIG. 1;

FIG. 6 is a perspective top view of the patient-specific glenoid guide of FIG. 5;

FIG. 7 is a perspective bottom view of the reusable guide holder of FIG. 5; and

FIG. 8 is an environmental view illustrating a guiding pin used during reaming in shoulder arthroplasty.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.

The present teachings generally provide a glenoid device that includes a reusable guide holder and a patient-specific alignment guide for use in shoulder joint replacement, shoulder resurfacing procedures and other procedures related to the shoulder joint or the various bones of the shoulder joint, including the glenoid face or cavity of the scapula, the humeral head and adjacent shoulder bones. The present teachings can be applied to anatomic shoulder replacement and reverse shoulder replacement. The reusable guide holder is not patient-specific. The patient-specific guide can be used either with conventional implant components or with patient-specific implant components and/or bone grafts that are prepared using computer-assisted image methods according to the present teachings. Computer modeling for obtaining three-dimensional images of the patient's anatomy using medical scans of the patient's anatomy (such as MRI, CT, ultrasound, X-rays, PET, etc.), any patient-specific prosthesis components and the patient-specific guides can be prepared using various commercially available CAD programs and/or software available, for example, by Object Research Systems or ORS, Montreal, Canada.

The patient-specific guide (and any associated patient-specific implants and bone grafts, when used) can be generally designed and manufactured based on computer modeling of the patient's 3-D anatomic image generated from medical image scans including, for example, X-rays, MRI, CT, PET, ultrasound or other medical scans. The patient-specific guide can have a three-dimensional engagement surface that is complementary and made to substantially mate and match in only one position (i.e., as a substantially negative or mirror or inverse surface) with a three-dimensional bone surface with or without associated soft tissues, which is reconstructed as a 3-D image via the aforementioned CAD or software. Very small irregularities need not be incorporated in the three-dimensional engagement surface. The patient-specific guide can include a custom-made guiding bore in an orientation selected to be aligned along the anatomic or reverse shoulder arthroplasty axis for the specific patient according to the preoperative surgical plan for the specific patient.

The three-dimensional geometry, shape and orientation of the various features of the patient-specific guide, as well as various patient-specific implants and bone grafts, if used, can be determined during the pre-operative planning stage of the procedure in connection with the computer-assisted modeling of the patient's anatomy. During the pre-operative planning stage, patient-specific instruments, custom, semi-custom or non-custom implants and other non-custom tools, can be selected and the patient-specific components can be manufactured for a specific-patient with input from a surgeon or other professional associated with the surgical procedure.

In the following discussion, the terms “patient-specific”, “custom-made” or “customized” are defined to apply to components, including tools such as alignment or drilling guides, implants, portions or combinations thereof, which include certain geometric features, including surfaces, curves, or other lines, and which are made to closely or nestingly conform and mate substantially as mirror-images or negatives or complementary surfaces of corresponding geometric features or anatomic landmarks of a patient's anatomy obtained or gathered during a pre-operative planning stage based on 3-D computer images of the corresponding anatomy reconstructed from image scans of the patient by computer imaging methods. Further, patient-specific guiding features, such as, guiding bores or other holes or openings that are included in patient-specific guides are defined as features that are made to have positions, orientations, dimensions, and axes specific to the particular patient's anatomy including various anatomic or reverse alignment axes based on the computer-assisted pre-operative plan associated with the patient.

The patient-specific guides can be configured to mate in alignment with natural anatomic landmarks by orienting and placing the corresponding alignment guide intra-operatively on top of the bone (with or without associated soft tissue at the discretion of the surgeon) to mate with corresponding landmarks. The anatomic landmarks function as passive fiducial identifiers or fiducial markers for positioning of the various alignment guides, drill guides or other patient-specific instruments.

The patient-specific guides can be made of any biocompatible material, including, polymer, ceramic, metal or combinations thereof. The patient-specific alignment guides can be disposable and can be combined or used with reusable and non patient-specific drilling, cutting, reaming and guiding components. The reusable guide holder can be made of metallic or polymeric materials that provide adequate rigidity for holding the patient-specific guide and guiding a drill. The reusable guide holder can be removable attached to an upper surface of the patient-specific guide such that an alignment pin or a drilling bit can be inserted through the guide holder and through the patient-specific guide along a patient-specific trajectory that corresponds to an anatomic or reverse alignment axis for the specific patient, as discussed below.

More specifically, the present teachings provide a reusable guide holder and a patient-specific glenoid guide that are used co-operatively for anatomic and reverse arthroplasty. The patient-specific glenoid guide of the present teachings can have a patient-specific engagement surface that references various portions of the shoulder joint and includes a patient-specific bore. The glenoid guide has a three-dimensional shape configured to align the guide holder to accurately position a guide wire or pin for later glenoid preparation and implantation procedures and for alignment purposes, including implant position control, implant version control, and implant inclination control for both anatomic and reverse arthroplasty.

In the following, when a portion of a glenoid guide is described as “referencing” a portion of the anatomy, it will be understood that the referencing portion of the glenoid guide is a patient-specific portion that mirrors or is a negative of the corresponding referenced anatomic portion.

In some embodiments, the glenoid guide can reference (substantially as a negative of) the face of the glenoid or glenoid cavity, avoiding the glenoid rim and any portion of the labrum. In other embodiments, the glenoid guide can reference (substantially as a negative of) the face of the glenoid and a portion of the glenoid rim. The glenoid guide can be designed to only remove a portion of the labrum (from 2-5 o'clock, for example) or the entire labrum. When the glenoid guide is designed to sit directly on bone rather than soft tissue, then the labrum is removed. In other embodiments, the glenoid guide can reference the labrum itself, such as when MRI scans are used to reconstruct details of the geometry of the soft tissue and the glenoid guide is designed references off soft tissue. In other embodiments, the glenoid guide can reference the glenoid face and a portion of the coracoid process or coracoid attachment or other bone surface that extends off the upper aspect of the glenoid.

A glenoid device 101 according to the present teachings is illustrated in use for anatomic shoulder arthroplasty of the glenoid of a scapula of a patient in FIG. 1 and for reverse shoulder arthroplasty in FIG. 2. The glenoid device 101 includes a reusable guide holder 100 and a patient-specific glenoid guide 200. The patient-specific glenoid guide 200 is constructed preoperatively, such as by milling a generic block, from medical image scans of the specific patient, as discussed above, and for the specific surgical procedure, anatomic or reverse shoulder arthroplasty.

Referring to FIGS. 3 and 4, the patient-specific glenoid guide 200 has a three-dimensional patient-specific body 209 extending between an upper (or outer) surface 202 and a lower (or inner) or anatomy-engaging and patient-specific surface 204 that references (substantially as a negative or inverse or mirror) the glenoid face 80 and may include all or a portion of the labrum 82, i.e., the peripheral cartilaginous structure that encircles and deepens the glenoid face 80. Alternatively, the labrum 82 can be completely removed such that the patient-specific glenoid surface 204 references and mirrors only a portion of the bone surface of the glenoid cavity or glenoid face 80. Optionally, the glenoid guide 200 can include a peripheral portion or peripheral lip 206 with a corresponding patient-specific peripheral surface 205 that engages a corresponding peripheral surface or glenoid rim 84 around the scapula of the patient.

The patient-specific glenoid guide 200 is configured to guide a guiding pin (such as the guiding pin 150 shown in FIGS. 1 and 2) and provide an implant alignment orientation for anatomic or reverse shoulder arthroplasty according to the preoperatively surgical plan for the specific patient. In FIG. 3, a patient-specific through bore 210 can extend from the upper surface 202 and through the patient-specific lower surface 204 of the glenoid guide 200 at a specific location and along an anatomic axis A that is determined and designed according to the pre-operative plan of the patient to define a patient-specific alignment axis and insertion point for a guiding pin 150 for anatomic shoulder arthroplasty. In FIG. 4, a patient-specific through bore 216 can extend from the upper surface 202 and through the lower surface 204 of the glenoid guide 200 at a specific location and along a reverse axis R that is determined and designed according to the pre-operative plan of the patient to define a patient-specific alignment axis and insertion point for a guiding pin 150 for reverse shoulder arthroplasty.

For the same patient, the reverse alignment axis R can have an inferior tilt α relative to the anatomic alignment axis A, such as, for example, a ten-degree inferior tilt α. The patient-specific bore 210 of FIG. 3 and the patient-specific bore 216 of FIG. 4 are prepared preoperatively in alignment to the corresponding anatomic and reverse alignment axes of the specific patient. Further, the three-dimensional geometry of the body 209, including variable depth and shape, is designed preoperatively such that the upper surface 202 of the patient-specific glenoid guide 200 can engage and guide the reusable guide holder 100 for anatomic or reverse shoulder arthroplasty alignment, as discussed below.

Referring to FIGS. 1 and 1A, the reusable guide holder 100 or 100A has a plate-like or substantially flat body 106 with upper and lower flat surfaces 110, 108 that are substantially parallel to one another. The overall shape of the body 106 can be oval approximating the shape of a typical glenoid surface. A handle shaft 102 is fixedly attached to and extends outward and away from the upper surface 110 at a 90-degree angle (FIG. 1) or other angle (FIG. 1A) relative to the upper surface 110. An elongated tubular guiding element 104 having an inner bore 112 is fixedly attached to and extends from the upper surface 110 at an angle relative to the upper surface 110. The bore 112 is collinear to a bore 114 through the body 106 such that a guiding pin 150 can be passed through the guide holder 100 and through the patient-specific glenoid guide 200 along the anatomic axis A, as shown in FIG. 1, or through the reverse axis R as shown in FIG. 2.

In other embodiments, the handle shaft 102 and the guide element 104 can be removably coupled to the body 106 for compact and easy packaging during transportation. The removable coupling can be a snap-fit, screw in or other removable attachment. It is noted that whether removably or fixedly attached to the body 106, the handle shaft 102 and the tubular guiding element 104 have fixed, non-custom orientations relative to the upper surface 110 of the body 106 of the guide holder 100.

The guide holder 100 also includes a plurality of short extensions, pegs or pins 120 that extend from the lower surface 108 of the guide holder 100 and can be received in corresponding mating bores or holes 212 preoperatively prepared through the upper surface 202 of the patient-specific glenoid guide 200 by a snap-fit or taper-to-taper or other type of quick connection. Three pins 120 and three corresponding holes 212 are shown in FIGS. 6 and 7. It is noted that location of pins 120 and holes 212 can be reversed, such that the pins extend from the glenoid guide 200 and the holes are formed in the guide holder 100. When the lower surface 108 of the guide holder 100 is placed in contact with the upper surface 202 of the patient-specific glenoid guide 200 such that the pins 120 are received in holes 212, the tubular guiding element 104 is oriented along the corresponding anatomic alignment axis A or reverse alignment axis R of the corresponding anatomic or reverse patient-specific glenoid guide 200 as shown in FIGS. 1 and 2. This is accomplished by taking into account the fixed (constant and non-custom) angle of the tubular guiding element 104 relative to the lower surface 108 (or upper surface 110, when these surfaces are substantially parallel) and preoperatively preparing the orientation of the upper surface 202 of the patient-specific glenoid guide 200 such that the anatomic axis A or reverse axis R that are patient-specific have the same orientation relative to the upper surface 202 as the non-custom and fixed orientation of the tubular guiding element 104 relative to the contacting lower surface 108.

The guide holder 100 and the patient-specific glenoid guide 200 can include corresponding markings indicating whether the patient-specific glenoid guide 200 is prepared for anatomic or reverse shoulder arthroplasty, facilitating easy identification and to avoid confusion. The markings can provide visual and keyed identification through the guide holder 100. The guide holder 100 can include two windows, anatomic window 130 and reverse window 132, correspondingly marked as A or anatomic and R or reverse, as illustrated in FIG. 7. The upper surface 202 of the patient-specific glenoid guide 200 includes one boss 214 or 218, as illustrated in FIG. 6. Boss 214 is positioned and configured to mate with the anatomic window 130 and boss 218 is configured to mate with the reverse window 132. By observing which of the two windows, anatomic 130 or reverse 132 receives a boss from the patient-specific glenoid guide 200, the surgeon can immediately verify that the patient-specific glenoid guide 200 is planned for anatomic or reverse shoulder arthroplasty.

Referring to FIGS. 1 and 2, with the guide holder 100 coupled to the patient-specific guide 200 and the patient-specific guide 200 registered and seated in a unique position on the glenoid of the specific patient, a guidewire or guiding pin 150 can be inserted through the tubular element 104 of the guide holder 100 and through the patient-specific guide 200 into the glenoid face 80 of the patient along the anatomic A or reverse R alignment axis depending on the pre-planned surgical procedure. Alternatively, a drill bit can be inserted through the tubular element 104 and a hole 90 drilled into the glenoid through the tubular element 104 for the guiding pin 150. The guide holder 100 and the patient-specific guide 200 can then be removed without removing the guiding pin 150. The guiding pin 150 can be used to guide a cannulated reamer 330 to ream the glenoid 80, as shown in FIG. 8, and also used for guiding an implant component along the patient-specific alignment direction A or R, correspondingly, for anatomic or reverse shoulder arthroplasty.

Generally, the patient-specific glenoid guide 200 of the present teachings references landmarks on the glenoid to orient the glenoid guide 200 in a predetermined orientation according to a preoperative plan for the specific patient. Landmarks can include, for example, the glenoid face 80 with or without any portion of the labrum, the coracoid process (or portions thereof or coracoid attachment), the glenoid rim and/or other landmarks of the scapula. The patient-specific glenoid guide 200 can be used to correctly orient a guide wire or guiding pin 150 along a patient-specific orientation that will be used in later glenoid preparation procedures in combination with a non-custom reusable guide holder 100, as discussed above. The patient-specific orientation can be designed and configured into the patient-specific glenoid guide 200 during the preoperative planning stage for the patient for implant positioning, implant version control, and implant inclination control.

As described above, the patient-specific glenoid guide 200 can fit around or on the exposed glenoid rim and surface substantially as a negative of the corresponding anatomy of the patient. Additionally, the glenoid guide 200 can match or correct defects and imperfections in the specific patient's glenoid. The overall, three-dimensional shape and size of the patient-specific guide 200 and the orientation of the upper surface 202 relative to the patient-specific anatomic alignment axis A or reverse alignment axis R are preoperatively designed such that the patient-specific guide 200 can be coupled to the reusable guide holder 100 and orient the tubular element 104 of the guide holder 100 along the corresponding anatomic alignment axis A or reverse alignment axis R.

The guide holder 100 and the patient-specific glenoid guide 200 can be included in any anatomic or reverse arthroplasty kit with corresponding implants and other instruments.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure.

Example embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, and methods, to provide a thorough understanding of embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that example embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some example embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail. 

What is claimed is:
 1. A glenoid device for preparing a shoulder joint of a patient comprising: a reusable guide holder having a body between an upper surface and a lower surface and a tubular element extending from the upper surface, the tubular element having a bore passing through the tubular element of the guide holder and aligned with a bore through the body; and a patient-specific glenoid guide having a body between an upper surface and a lower surface, wherein the lower surface of the patient-specific glenoid guide is a patient-specific surface configured as a negative surface of a glenoid face based on an image of a shoulder joint of a patient reconstructed preoperatively from image scans of the shoulder joint of the patient and wherein the upper surface of the glenoid guide is configured to be coupled to and contact the lower surface of the guide holder, such that the bore of the tubular element and the bore of the body are aligned with a patient-specific bore through the body of the patient-specific glenoid guide and along an alignment axis of the patient-specific glenoid guide corresponding to an axis of the shoulder joint determined according to a pre-operative plan of the patient, the patient-specific bore and the corresponding alignment axis being disposed at an orientation relative to the glenoid face according to a preoperative plan for the patient.
 2. The glenoid device of claim 1, wherein the body of the guide holder is plate like and the lower surface is flat.
 3. The glenoid device of claim 1, wherein the alignment axis is an anatomic alignment axis of the shoulder joint of the patient.
 4. The glenoid device of claim 1, wherein the alignment axis is a reverse alignment axis of the shoulder joint of the patient.
 5. The glenoid device of claim 1, wherein the guide holder is coupled to the patient-specific glenoid guide by a plurality of pins received into corresponding holes of the upper surface of the patient-specific glenoid guide.
 6. The glenoid device of claim 1, wherein the patient-specific glenoid guide includes a single boss extending from the upper surface at a location indicative of one of anatomic and reverse shoulder arthroplasty use.
 7. The glenoid device of claim 6, wherein the guide holder includes first and second windows, the first window marked for anatomic use and the second window marked for reverse use.
 8. The glenoid device of claim 7, wherein the single boss is received in one of the first and second windows to provide an indication of anatomic or reverse shoulder arthroplasty.
 9. The glenoid device of claim 1, wherein the body of the patient-specific glenoid guide has a three-dimensional shape and size configured to align the bore of the body of the glenoid holder along the patient-specific bore through the body of the patient-specific glenoid guide.
 10. The glenoid guide of claim 1, wherein the guide holder includes a handle shaft attached to the upper surface of the body of the guide holder.
 11. The glenoid guide of claim 1, wherein the tubular element is oriented at a fixed orientation relative to the lower surface of the body of the guide holder.
 12. The glenoid device of claim 1, wherein the patient-specific glenoid guide includes a peripheral portion that engages a corresponding peripheral surface of the glenoid of the patient.
 13. The glenoid device of claim 1, wherein the upper surface and the lower surface of the patient-specific glenoid guide are preoperatively designed such that the patient-specific glenoid guide can be coupled to the reusable guide holder and orient the tubular element of the reusable guide holder along the corresponding alignment axis when the lower surface of the patient-specific glenoid guide is positioned against the glenoid face.
 14. A glenoid device for preparing a shoulder joint of a patient comprising: a reusable guide holder having a handle shaft and the reusable guide holder defining a bore there through at a fixed orientation relative to the handle shaft; and a patient-specific glenoid guide having a body between an upper surface and a lower surface, wherein the lower surface of the patient-specific glenoid guide is a patient-specific surface configured to nestingly mate and conform to a corresponding surface of a glenoid face of a patient based on an image of a shoulder joint of the patient as reconstructed preoperatively from image scans of the shoulder joint of the patient, the body of the patient-specific glenoid guide defining a bore having a patient-specific orientation between the upper and lower surfaces so that the patient-specific bore is aligned along an alignment axis corresponding to an anatomic or reverse axis of the shoulder joint of the patient determined according to a pre-operative plan of the patient, the body of the patient-specific glenoid guide configured such that the bore of the guide holder and the patient-specific bore of the patient-specific glenoid guide are aligned along the alignment axis when the guide holder and the patient-specific glenoid guide are directly coupled to one another.
 15. The glenoid device of claim 14, wherein the reusable guide holder includes a tubular element attached to an upper surface of the guide holder and having a bore aligned with the bore of the guide holder.
 16. The glenoid device of claim 14, wherein the guide holder has a substantially flat body between the upper surface and the lower surface.
 17. The glenoid device of claim 16, wherein the glenoid holder includes first and second windows marked with designations indicating anatomic and reverse shoulder arthroplasty.
 18. The glenoid device of claim 17, wherein the patient-specific glenoid guide includes a boss extending from the upper surface of the body of the patient-specific glenoid guide and configured to be received in one of the first and second windows of the guide holder to indicate anatomic or reverse shoulder arthroplasty.
 19. The glenoid device of claim 14, wherein the guide holder is directly coupled to the patient-specific glenoid guide via a plurality of pins received in corresponding holes of the patient-specific glenoid guide.
 20. The glenoid device of claim 14, wherein the patient-specific glenoid guide includes a peripheral portion that engages a corresponding peripheral surface of the glenoid of the patient.
 21. The glenoid device of claim 14, wherein the lower surface of the patient-specific glenoid guide is shaped and the bore of the patient-specific glenoid guide is oriented between the upper and lower surfaces such that the bore of the patient-specific glenoid guide aligns with the alignment axis of the patient when the lower surface of the patient-specific glenoid guide is mated to the glenoid face, the alignment axis of the patient being based on a preoperative plan for the patient. 